Referat
PARKINSON DISEASE
Oleh: Bima Baikuni, S. Ked I1A010059
Pembimbing: d. !il" Run#u$ene, S%.S
BA&IAN'S() I!(* PEN+AKI SARA) )K *N!A( - RS*D PENDIDIKAN *!IN BANAR(ASIN Se%#embe, /01
DA)AR ISI
HALAMAN JUDUL...................................... JUDUL............................................................. ....................................................... ................................ DAFTAR DAFTAR ISI........................................... ISI.................................................................. .............................................. ........................................ ................. 1 BAB I PENDAHUL PENDAHULUAN.. UAN....... .......... .......... .......... .......... ......... ......... .......... .......... .......... .......... .......... ............... ................... .............. ..... 2 BAB II PEMBAHASAN.............................. PEMBAHASAN..................................................... .............................................. .................................. ........... 3 A. Definisi.............................................. Definisi..................................................................... ........................................................ ................................. 3 B. Etiologi.. Etiologi....... .......... .......... ......... ......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ............. .................. ................... ............. .... 4 . E!i"e#iologi............... E!i"e#iologi...................................... .............................................. .............................................. ................................. .......... 4 D. P$tofisiologi....................................... P$tofisiologi.............................................................. .............................................. ................................. .......... % E. M$nifest$si M$nifest$si &linis..... &linis.......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ............. .................. ............. ... ' F. Pen"e($t$n Di$gnosis.................................................... Di$gnosis........................................................................... ............................. ...... 12 ). Pen$t$l$(s$n$$n........................................................ Pen$t$l$(s$n$$n............................................................................... ................................. .......... 14 H. P*ognosis................................... P*ognosis.......................................................... ............................................................... ........................................ . 1' BAB III PENUTUP................................. PENUTUP........................................................ .............................................. ....................................... ................ DAFTAR PUSTA&A
2
BAB I PENDA*!*AN
Pen+$(it P$*(inson #e*,!$($n !en+$(it ne,*o"egene*$tif (e 2 !$ling se*ing "i-,#!$i setel$ !en+$(it Al/ei#e*. Be*0$g$i ge-$l$ !en+$(it P$*(inson $nt$*$ l$in t*e#o* $(t, isti*$$t tel$ "i(e#,($($n se-$( )$len t$,n 13'21 0$($n 0e*0$g$i #$5$# t*e#o* s,"$ "ig$#0$*($n t$,n 2% se0el,# #$sei ole 0$ngs$ In"i$. N$#,n D*. J$#es P$*(inson !$"$ t$,n 1'16 +$ng !e*t$#$ ($li #en,lis "es(*i!si ge-$l$ !en+$(it P$*(inson "eng$n *in5i "$n leng($! (e5,$li (ele#$$n otot seingg$ "ise0,tn+$ !$*$l+sis $git$ns. P$"$ t$,n 1'74 Blo5g "$n M$*ines5o #en",g$ s,0st$nsi$ nig*$ se0$g$i lo(,s lesi "$n t$,n 1717 T*eti$(off #en+i#!,l($n "$*i $sil !eneliti$n !ost #o*te# !en"e*it$ !en+$(it P$*(inson !$"$ "ise*t$sin+$ 0$$ $"$ (es$#$$n lesi +$ng "ite#,($n +$it, lesi "is,0st$nsi$ nig*$. Le0i l$n-,t se5$*$ te*!is$ "$n "eng$n 5$*$ 0e*0e"$ "it,n-,(($n Bein $*lsson "$n Ho*n+(iei5/ t$,n 17%$n 0$$ !en,*,n$n ($"$* "o!$#ine se0$g$i (el$in$n 0io(i#i$i +$ng #en"$s$*i !en+$(it P$*(inson. Pen+$(it P$*(inson te*-$"i "i sel,*, ",ni$ -,#l$ !en"e*it$ $nt$*$ !*i$ "$n $nit$ sei#0$ng. % 8 1 9 o*$ng +$ng te*-$ng(it !en+$(it !$*(inson ge-$l$ $$ln+$ #,n5,l se0el,# ,si$ 4 t$,n t$!i *$t$*$t$ #en+e*$ng !en"e*it$ !$"$ ,si$ :% t$,n. Se5$*$ (esel,*,$n !eng$*, ,si$ !$"$ ,#,#n+$ #en5$!$i 1 9 "i sel,*, ",ni$ "$n 1: 9 "i E*o!$ #ening($t "$*i : 9 !$"$ ,si$ : 8 :4 t$,n s$#!$i 3% 9 !$"$ ,si$ '% 8 '7 t$,n. Di A#e*i($ Se*i($t $"$ se(it$* %. !en"e*it$ !$*(inson. Di In"onesi$ sen"i*i "eng$n -,#l$ !en",",( 21 -,t$ o*$ng "i!e*(i*$($n $"$ se(it$* 2.4. !en"e*it$. R$t$*$t$ ,si$ !en"e*it$ "i $t$s % t$,n "eng$n *ent$ng ,si$ses,$i "eng$n !eneliti$n +$ng "il$(,($n "i 0e0e*$!$ *,#$ s$(it "i S,#$te*$ "$n J$$ 1' ingg$ '% t$,n. St$tisti( #en,n-,(($n 0$i( "i l,$* nege*i #$,!,n "i "$l$# nege*i lel$(i le0i 0$n+$( te*(en$ "i0$n"ing !e*e#!,$n ;3<2= "eng$n $l$s$n +$ng 0el,# "i(et$,i.
3
BAB II INA*AN P*SAKA
A. DE)INISI
Pen+$(it !$*(inson $"$l$ !en+$(it ne,*o"egene*$tif !*og*esif +$ng 0e*($it$n e*$t "eng$n ,si$. Se5$*$ !$tologis !en+$(it !$*(inson "it$n"$i ole "egene*$si ne,*onne,*on 0e*!ig#en ne,*o#el$#in te*,t$#$ "i !$*s (o#!$(t$ s,0st$nsi$ nig*$ +$ng "ise*t$i in(l,si sito!l$s#i( eosinofili( ;Le+ 0o"ies= $t$, "ise0,t -,g$ !$*(insonis#e i"io!$ti( $t$, !*i#e*. Se"$ng($n P$*(inonis#e $"$l$ s,$t, sin"*o# +$ng "it$n"$i ole t*e#o* $(t, isti*$$t *igi"it$s 0*$"i(inesi$ "$n il$ngn+$ *efle(s !ost,*$l $(i0$t !en,*,n$n ($"$* "o!$#ine "eng$n 0e*0$g$i #$5$# se0$0. Sin"*o# ini se*ing "ise0,t se0$g$i Sin"*o# P$*(inson.
B. K!ASI)IKASI
Pen+$(it !$*(inson "$!$t "i0$gi $t$s 3 ($tego*i +$it, < 1. P$*(inson !*i#e*>i"io!$ti(>!$*$l+sis $git$ns. Se*ing "i-,#!$i "$l$# !*$(te( se$*i$*i "$n (*onis tet$!i !en+e0$0n+$ 0el,# -el$s. &i*$(i*$ 6 "$*i ' ($s,s !$*(inson te*#$s,( -enis ini. 2. P$*(inson se(,n"e* $t$, si#to#$ti( D$!$t "ise0$0($n !$s5$ ensef$litis ?i*,s !$s5$ infe(si l$in < t,0e*(,losis sifilis
#eningo?$s(,le*.
tetrahydropyridine
To(sin
;MPTP=
Mn
se!e*ti @
1-methyl-4-phenyl-1,2,3,6si$ni"$.
@0$to0$t$n
+$ng
#eng$#0$t *ese!to* "o!$#in "$n #en,*,n($n 5$"$ng$n "o!$#in #is$ln+$ golong$n fenoti$/in *ese*!in tet*$0en$/in "$n l$inl$in #is$ln+$ !e*"$*$$n se*e0*$l !$s5$ t*$,#$ +$ng 0e*,l$ng,l$ng !$"$ !etin-, inf$*( l$(,ne* t,#o* se*e0*i i!o!$*$ti*oi" "$n ($lsifi($si. 3. Sin"*o# P$*(inson Pl,s ;M,lti!le S+ste# Degene*$tion= P$"$ (elo#!o( ini ge-$l$n+$ $n+$ #e*,!$($n se0$gi$n "$*i g$#0$*$n !en+$(it (esel,*,$n. Jenis ini 0is$ "i"$!$t !$"$ P*og*essi?e s,!*$n,5le$*
4
!$ls+
M,lti!le
st*i$tonig*$l
s+ste#
$t*o!+
oli?o!onto5e*e0ell$*
;sin"*o#
Shy-drager,
"egene*$tion
"egene*$si
!$*(insonis#
$#+ot*o!+ s+n"*o#e= Degene*$si (o*ti(o0$s$l g$nglioni( Sin"*o# "e#ensi$ Hi"*osef$l,s no*#otensif "$n &el$in$n e*e"ite* ;Pen+$(it ilson !en+$(it H,ntington P$*(insonis#e f$#ili$l "eng$n ne,*o!$ti !e*i!e*$l=.
2. EIO!O&I
Etiologi P$*(inson !*i#e* #$si 0el,# "i(et$,i. Te*"$!$t 0e0e*$!$ ",g$$n "i $nt$*$n+$ i$l$ < infe(si ole ?i*,s +$ng non(on?ension$l ;0el,# "i(et$,i= *e$(si $0no*#$l te*$"$! ?i*,s +$ng s,"$ ,#,# !e#$!$*$n te*$"$! /$t to(si( +$ng 0el,# "i(et$,i te*-$"in+$ !en,$$n +$ng !*e#$t,* $t$, "i!e*5e!$t. P$*(inson "ise0$0($n ole *,s$(n+$ selsel ot$( te!$tn+$ "i s,0st$nsi nig*$. S,$t, (elo#!o( sel +$ng #eng$t,* ge*$($nge*$($n +$ng ti"$( "i(een"$(i ;involuntary=. A(i0$tn+$ !en"e*it$ ti"$( 0is$ #eng$t,*>#en$$n ge*$($nge*$($n +$ng ti"$( "is$"$*in+$. Me($nis#e 0$g$i#$n$ (e*,s$($n it, 0el,# -el$s 0en$* $($n tet$!i $"$ 0e0e*$!$ f$(to* *esi(o ; #,ltif$(to*i$l = +$ng tel$ "ii"entifi($si($n +$it, < 1. Usi$ < Insi"en #ening($t "$*i 1 !e* 1. !en",",( !$"$ ,si$ % s$#!$i 2 "$*i 1. !en",",( !$"$ ,si$ ' t$,n. H$l ini 0e*($it$n "eng$n *e$(si #i(*ogili$l +$ng #e#!eng$*,i (e*,s$($n ne,*on$l te*,t$#$ !$"$ s,0st$nsi$ nig*$ !$"$ !en+$(it !$*(inson. 2. )eneti( < Peneliti$n #en,n-,(($n $"$n+$ #,t$si geneti( +$ng 0e*!e*$n !$"$ !en+$(it !$*(inson. $it, #,t$si !$"$ gen $sin,(lein !$"$ leng$n !$n-$ng (*o#oso# 4 ;PAR&1= !$"$ !$sien "eng$n P$*(insonis# $,toso#$l "o#in$n. P$"$ !$sien "eng$n $,toso#$l *esesif !$*(inson "ite#,($n "elesi "$n #,t$si !oint !$"$ gen parkin ;PAR&2= "i (*o#oso# :. Sel$in it, -,g$ "ite#,($n $"$n+$ "isf,ngsi #ito(on"*i$. A"$n+$ *i$+$t !en+$(it !$*(inson !$"$ (el,$*g$ #ening$($t($n f$(to* *esi(o #en"e*it$ !en+$(it !$*(inson se0es$* '' ($li !$"$ ,si$ (,*$ng "$*i 6 t$,n "$n 2' ($li !$"$ ,si$ le0i "$*i 6
%
t$,n. Mes(i!,n s$ng$t -$*$ng -i($ "ise0$0($n ole (et,*,n$n ge-$l$ !$*(insonis#e t$#!$( !$"$ ,si$ *el$tif #,"$. &$s,s($s,s geneti($ "i USA s$ng$t se"i(it 0el,# "ite#,($n ($s,s geneti($ !$"$ 1 !en"e*it$ +$ng "i!e*i(s$. Di E*o!$ !,n "e#i(i$n. Peneliti$n "i Je*#$n #ene#,($n $sil nol !$"$ 6 !en"e*it$. onto (l$si( "$*i !en+e0$0 geneti($ "ite#,($n !$"$ (el,$*g$(el,$*g$ "i It$li$ ($*en$ ($s,s !en+$(it it, te*-$"i !$"$ ,si$ 4: t$,n. 3. F$(to* Ling(,ng$n $= Ceno0ioti( < Be*,0,ng$n e*$t "eng$n !$!$*$n !estisi"$ +$ng "$!$t #eni#0,l($n (e*,s$($n #ito(on"*i$. 0= Pe(e*-$$n < Le0i 0$n+$( !$"$ o*$ng "eng$n !$!$*$n #et$l +$ng le0i tinggi "$n l$#$. 5= Infe(si < P$!$*$n ?i*,s infl,en/$ int*$,te*o "i",g$ t,*,t #en-$"i f$(to* !*e"es!osisi
!en+$(it !$*(inson #el$l,i (e*,s$($n s,0st$nsi$ nig*$.
Peneliti$n !$"$ e$n #en,n-,(($n $"$n+$ (e*,s$($n s,0st$nsi$ nig*$ ole infe(si Nocardia astroides. "= Diet < &ons,#si le#$( "$n ($lo*i tinggi #ening($t($n st*ess o(si"$tif s$l$ s$t, #e($nis#e (e*,s$($n ne,*on$l !$"$ !en+$(it !$*(inson. Se0$li(n+$(o!i #e*,!$($n ne,*o!*ote(tif. 4. R$s < $ng($ (e-$"i$n P$*(inson le0i tinggi !$"$ o*$ng (,lit !,ti "i0$n"ing($n (,lit 0e*$*n$. %. T*$,#$ (e!$l$ < e"e*$ (*$nio se*e0*$l 0is$ #en+e0$0($n !en+$(it !$*(inson #es(i !e*$n$nn+$ #$si 0el,# -el$s 0en$*. :. St*ess "$n "e!*esi < Be0e*$!$ !eneliti$n #en,n-,(($n "e!*esi "$!$t #en"$,l,i ge-$l$ #oto*i(. De!*esi "$n st*ess "i,0,ng($n "eng$n !en+$(it !$*(inson ($*en$ !$"$ st*ess "$n "e!*esi te*-$"i !ening($t$n t,*no?e* ($te(ol$#in +$ng #e#$5, st*ess o(si"$tif.
:
D. PAO)ISIO!O&I
Se5$*$ ,#,# "$!$t "i($t$($n 0$$ !en+$(it P$*(inson te*-$"i ($*en$ !en,*,n$n ($"$* "o!$#ine $(i0$t (e#$ti$n ne,*on "i s,0st$nsi$ nig*$ !$*s 5o#!$5t$ ;SN5= se0es$* 4%9 +$ng "ise*t$i "eng$n in(l,si sito!l$s#i( eosinofili( ; Ley !odies= "eng$n !en+e0$0 #,ltif$(to*. S,0st$nsi$ nig*$ ;se*ing "ise0,t !lack su!stance= $"$l$ s,$t, *egion (e5il "i ot$( ;0*$in ste#= +$ng te*let$( se"i(it "i $t$s #e",ll$ s!in$lis. B$gi$n ini #en-$"i
!,s$t
5ont*ol>(oo*"in$si
"$*i
sel,*,
!e*ge*$($n.
Selseln+$
#eng$sil($n ne,*ot*$ns#itte* +$ng "ise0,t "o!$#ine +$ng 0e*f,ngsi ,nt,( #eng$t,* sel,*, ge*$($n otot "$n (esei#0$ng$n t,0, +$ng "il$(,($n ole siste# s$*$f !,s$t. Do!$#ine "i!e*l,($n ,nt,( (o#,ni($si ele(t*o(i#i$ $nt$*$ selsel ne,*on "i ot$( te*,t$#$ "$l$# #eng$t,* !e*ge*$($n (esei#0$ng$n "$n *efle(s !ost,*$l se*t$ (el$n5$*$n (o#,ni($si ;0i5$*$=. P$"$ !en+$(it P$*(inson selsel ne,*on "i SN5 #eng$l$#i "egene*$si seingg$ !*o",(si "o!$#ine #en,*,n "$n $(i0$tn+$ se#,$ f,ngsi ne,*on "i s+ste# s$*$f !,s$t ;SSP= #en,*,n "$n #eng$sil($n (el$#0$t$n ge*$( ;0*$"i(inesi$= (el$#0$t$n 0i5$*$ "$n 0e*!i(i* ;0*$"if*eni$= t*e#o* "$n (e($,$n ;*igi"it$s=. Hi!otesis te*0$*, !*oses !$tologi +$ng #en"$s$*i !*oses "egene*$si ne,*on SN5 $"$l$ st*ess o(si"$tif. St*ess o(si"$tif #en+e0$0($n te*0ent,(n+$ fo*#$si o(si*$"i($l se!e*ti "o!$#ine ,inon +$ng "$!$t 0e*e$(si "eng$n $lf$ sin,(lein ;"ise0,t !*otofi0*ils=. Fo*#$si ini #en,#!,( ti"$( "$!$t "i g*$"$si ole ,0i,itin!*ote$so#$l !$t$+ seingg$ #en+e0$0($n (e#$ti$n selsel SN5. Me($nis#e !$togeni( l$in +$ng !e*l, "i!e*ti#0$ng($n $nt$*$ l$in <
Efe( l$in "$*i st*es o(si"$tif $"$l$ te*-$"in+$ *e$(si $nt$*$ o(si*$"i($l "eng$n nitric-o"ide ;N@= +$ng #eng$sil($n pero"ynitric-radical .
&e*,s$($n #ito(on"*i$ se0$g$i $(i0$t !en,*,n$n !*o",(si $"enosin t*ifosf$t ;ATP= "$n $(,#,l$si ele(t*onele(t*on +$ng #e#!e*0,*,( st*es o(si"$tif $(i*n+$ #eng$sil($n !ening($t$n $!o!tosis "$n (e#$ti$n sel.
Pe*,0$$n $(i0$t !*oses infl$#$si "i sel nig*$ #e#!*o",(si sito(in +$ng #e#i5, $!o!tosis selsel SN5.
6
E. &EA!A K!INIS
)e-$l$ Moto*i(
'
)$#0$*$n (linis !en+$(it P$*(inson
7
a.
T*e#o* )e-$l$ !en+$(it !$*(inson se*ing l,!,t "$*i !$n"$ng$n $$# "$n
"i$ngg$! se0$g$i s,$t, $l +$ng l,#*$ te*-$"i !$"$ o*$ng t,$. S$l$ s$t, 5i*i ($s "$*i !en+$(it !$*(inson $"$l$ t$ng$n tremor ;0e*get$*= -i($ se"$ng 0e*isti*$$t. N$#,n -i($ o*$ng it, "i#int$ #el$(,($n ses,$t, get$*$n te*se0,t ti"$( te*li$t l$gi. It, +$ng "ise0,t resting tremor +$ng il$ng -,g$ se$(t, ti",*. T*e#o* te*"$!$t !$"$ -$*i t$ng$n t*e#o* ($s$* !$"$ sen"i #et$($*!of$l$ngis ($"$ng($"$ng t*e#o* se!e*ti #engit,ng ,$ng log$# $t$, #e#,l,ng#,l,ng ; pill rolling =. P$"$ sen"i t$ng$n fle(sie(stensi $t$, !*on$sis,!in$si !$"$ ($(i fle(sie(stensi (e!$l$ fle(sie(stensi $t$, #enggeleng #,l,t #e#0,($ #en,t,! li"$ te*-,l,*te*t$*i(. T*e#o* ini #engil$ng $(t, isti*$$t "$n #enge0$t $(t, e#osi te*$ngs$ng ;resting# alternating tremor =. T*e#o* ti"$( $n+$ te*-$"i !$"$ t$ng$n $t$, ($(i tet$!i 0is$ -,g$ te*-$"i !$"$ (elo!$( #$t$ "$n 0ol$ #$t$ 0i0i* li"$ "$n -$*i t$ng$n ;se!e*ti o*$ng
#engit,ng
,$ng=.
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*o"$ +$ng
0e*gigi
seingg$ ge*$($nn+$
#en-$"i
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!$t$>!,t,s!,t,s. Sel$in "i t$ng$n #$,!,n "i ($(i (e($(,$n it, 0is$ -,g$ te*-$"i "i lee*. A(i0$t (e($(,$n it, ge*$($nn+$ #en-$"i ti"$( $l,s l$gi se!e*ti !reak-dance. )e*$($n +$ng ($(, #e#0,$t !en"e*it$ $($n 0e*-$l$n "eng$n !ost,*
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1
g*$?it$sin+$ $g$* ti"$( -$t, l$ng($n+$ #en-$"i 5e!$t tet$!i !en"e( !en"e(. A"$n+$ i!e*toni !$"$ otot fle(so* e(stenso* "$n i!e*toni sel,*, ge*$($n $l ini ole ($*en$ #ening($tn+$ $(tifit$s #oto*ne,*on $lf$ $"$n+$ feno#en$ *o"$ 0e*gigi ;cogheel phenomenon=. 5. A(inesi$>B*$"i(inesi$ &e",$ ge-$l$ "i $t$s 0i$s$n+$ #$si (,*$ng #en"$!$t !e*$ti$n seingg$ t$n"$ $(inesi$>0*$"i(inesi$ #,n5,l. )e*$($n !en"e*it$ #en-$"i se*0$ l$#0$t. D$l$# !e(e*-$$n se$*i$*i !,n 0is$ te*li$t !$"$ t,lis$n>t$n"$ t$ng$n +$ng se#$(in #enge5il s,lit #engen$($n 0$-, l$ng($ #en-$"i !en"e( "$n "ise*et. &es$"$*$n #$si tet$! 0$i( seingg$ !en"e*it$ 0is$ #en-$"i te*te($n ;st*es= ($*en$ !en+$(it it,. $-$ #en-$"i t$n!$ e(s!*esi. &e"i!$n "$n li*i($n #$t$ 0e*(,*$ng s,$*$ #en-$"i (e5il *efle(s #enel$n 0e*(,*$ng seingg$ se*ing (el,$* $i* li,*. )e*$($n ?ol,nte* #en-$"i l$#0$t seingg$ 0e*(,*$ngn+$ ge*$( $sosi$tif #is$ln+$ s,lit ,nt,( 0$ng,n "$*i (,*si s,lit #e#,l$i 0e*-$l$n l$#0$t #eng$#0il s,$t, o0+e( 0il$ 0e*0i5$*$ ge*$( li"$ "$n 0i0i* #en-$"i l$#0$t. B*$"i(inesi$ #eng$(i0$t($n 0e*(,*$ngn+$ e(s!*esi #,($ se*t$ #i#i( "$n ge*$($n s!ont$n +$ng 0e*(,*$ng #is$ln+$ $-$ se!e*ti to!eng (e"i!$n #$t$ 0e*(,*$ng 0e*(,*$ngn+$ ge*$( #enel$n l,"$ seingg$ l,"$ s,($ (el,$* "$*i #,l,t. ". Ti0$ti0$ Be*enti $t$, R$g,*$g, ,nt,( Mel$ng($ )e-$l$ l$in $"$l$ $ree%ing +$it, 0e*enti "i te#!$t s$$t #$, #,l$i #el$ng($ se"$ng 0e*-$l$n $t$, 0e*!,t$* 0$li( "$n start hesitation +$it, *$g,*$g, ,nt,( #,l$i #el$ng($. Bis$ -,g$ te*-$"i se*ing (en5ing "$n se#0elit. Pen"e*it$ #en-$"i l$#0$t 0e*!i(i* "$n "e!*esi. Hil$ngn+$ *efle(s !ost,*$l "ise0$0($n (eg$g$l$n integ*$si "$*i s$*$f !*o!iose!tif "$n l$0i*in "$n se0$gi$n (e5il i#!,ls "$*i #$t$ !$"$ le?el t$l$#,s "$n g$ngli$ 0$s$lis +$ng $($n #engg$ngg, (e$s!$"$$n !osisi t,0,. &e$"$$n ini #eng$(i0$t($n !en"e*it$ #,"$ -$t,. e. Mi(*og*$fi$
11
T,lis$n t$ng$n se5$*$ g*$",$l #en-$"i (e5il "$n *$!$t !$"$ 0e0e*$!$ ($s,s $l ini #e*,!$($n ge-$l$ "ini. f. L$ng($ "$n g$+$ -$l$n ;si($! P$*(inson= Be*-$l$n "eng$n l$ng($ (e5il #enggese* "$n #$(in #en-$"i 5e!$t ;marche a petit pas= st$"i,# l$n-,t (e!$l$ "ifle(si($n (e "$"$ 0$, #e#0eng(o( (e "e!$n !,ngg,ng #eleng(,ng 0il$ 0e*-$l$n. g. Bi5$*$ #onoton H$l ini ($*en$ 0*$"i(inesi$ "$n *igi"it$s otot !e*n$!$s$n !it$ s,$*$ otot l$*ing seingg$ 0il$ 0e*0i5$*$ $t$, #eng,5$!($n ($t$($t$ +$ng #onoton "eng$n ?ol,#e s,$*$ $l,s ;s,$*$ 0isi($n= +$ng l$#0$t. . Di#ensi$ A"$n+$ !e*,0$$n st$t,s #ent$l sel$#$ !e*-$l$n$n !en+$(itn+$ "eng$n "efisit (ognitif. i. )$ngg,$n 0e$?io*$l L$#0$tl$,n #en-$"i "e!en"en ;te*g$nt,ng (e!$"$ o*$ng l$in= #,"$ t$(,t si($! (,*$ng teg$s "e!*esi. $*$ 0e*!i(i* "$n *es!on te*$"$!
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)e-$l$ non #oto*i( $. Disf,ngsi otono# ∼
&e*ing$t 0e*le0i$n $i* l,"$ 0e*le0i$n g$ngg,$n sfingte* te*,t$#$ in(ontinensi$ "$n i!otensi o*tost$ti(
∼
&,lit 0e*#in+$( "$n infe(si (,lit se0o*oi(
∼
Pengel,$*$n ,*in +$ng 0$n+$(
∼
)$ngg,$n se(s,$l +$ng 0e*,0$ f,ngsi "it$n"$i "eng$n #ele#$n+$ $s*$t se(s,$l !e*il$(, o*g$s#e.
12
0. )$ngg,$n s,$s$n$ $ti !en"e*it$ se*ing #eng$l$#i "e!*esi 5. )$ng,$n (ognitif #en$ngg$!i *$ngs$ng$n l$#0$t ". )$ngg,$n ti",* !en"e*it$ #eng$l$#i (es,lit$n ti",* ;inso#ni$= e. )$ngg,$n sens$si ∼
(e!e($$n
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*,$ng
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∼
+!otension o*tost$ti5 s,$t, (eg$g$l$n siste#s$*$f otono# ,nt,( #el$(,($n
!en+es,$i$n
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∼
atau anosmia'.
). DIA&NOSIS
Di$gnosis !en+$(it P$*(inson "iteg$(($n 0e*"$s$*($n (*ite*i$ < 1. Se5$*$ (linis •
Di"$!$t($n 2 "$*i 3 t$n"$ ($*"in$l g$ngg,$n #oto*i( < t*e#o* *igi"it$s 0*$"i(inesi$ $t$,
•
3
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t$n"$
#oto*i(
<
t*e#o* *igi"it$s
0*$"i(inesi$
"$n
(eti"$(st$0il$n !ost,*$l. 2. &*iete*i$ &olle* •
Di"$!$ti 2 "$*i 3 t$n"$ 5$*"in$l g$ngg,$n #oto*i( < t*e#o* s$$t isti*$$t $t$, g$ngg,$n *efle(s !ost,*$l *igi"it$s 0*$"i(inesi$ +$ng 0e*l$ngs,ng 1 t$,n $t$, le0i.
•
Res!ons te*$"$! te*$!i le?o"o!$ +$ng "i0e*i($n s$#!$i !e*0$i($n se"$ng ;#ini#$l 1. #g>$*i sel$#$ 1 0,l$n= "$n l$#$ !e*0$i($n 1 t$,n $t$, le0i.
3. &*ite*i$ )el0 )il#$n •
)e-$l$ (elo#!o( A ;($s ,nt,( !en+$(it P$*(inson= te*"i*i "$*i < 1= Resting t*e#o*
13
2= B*$"i(inesi$ 3= Rigi"it$s 4= Pe*#,l$$n $si#et*is •
)e-$l$ (linis (elo#!o( B ;ge-$l$ "ini t$( l$/i#= "i$gnos$ $lte*n$tif te*"i*i "$*i < 1= Inst$0ilit$s !ost,*$l +$ng #enon-ol !$"$ 3 t$,n !e*t$#$ 2= Feno#en$ t$( "$!$t 0e*ge*$( s$#$ se($li ;f*ee/ing= !$"$ 3 t$,n !e*t$#$ 3= H$l,sin$si ;ti"$( $"$ ,0,ng$n "eng$n !engo0$t$n= "$l$# 3 t$,n !e*t$#$ 4= De#ensi$ se0el,# ge-$l$ #oto*i( !$"$ t$,n !e*t$#$.
Di$gnosis G possi!le < te*"$!$t !$ling se"i(it 2 "$*i ge-$l$ (elo#!o( A "i#$n$ s$l$ s$t, "i$nt$*$n+$ $"$l$ t*e#o* $t$, 0*$"i(inesi$ "$n t$( te*"$!$t ge-$l$ (elo#!o( B l$#$ ge-$l$ (,*$ng "$*i 3 t$,n "ise*t$i *es!on -el$s te*$"$! le?o"o!$ $t$, "o!$#ine $gonis.
Di$gnosis G pro!a!le < te*"$!$t !$ling se"i(it 3 "$*i 4 ge-$l$ (elo#!o( A "$n ti"$( te*"$!$t ge-$l$ "$*i (elo#!o( B l$#$ !en+$(it !$ling se"i(it 3 t$,n "$n *es!on -el$s te*$"$! le?o"o!$ $t$, "o!$#ine $gonis.
Di$gnosis
G pasti
<
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se#,$
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!e#e*i(s$$n isto!$tologis +$ng !ositif.
&. PENAA!AKSANAAN
Pen+$(it P$*(inson $"$l$ s,$t, !en+$(it "egene*$tif +$ng 0e*(e#0$ng !*og*esif
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!en+$(it P$*(inson. St*$tegi ini "it,-,($n ,nt,(
#e#!e*t$$n($n (,$lit$s i",! !en"e*it$n+$.
1. ea%i 3amak4l4gik
14
$. @0$t !engg$nti "o!$#ine ;Le?o"o!$ $*0i"o!$= Le?o"o!$ #e*,!$($n !engo0$t$n ,t$#$ ,nt,( !en+$(it !$*(inson. Di "$l$# ot$( le?o"o!$ "i*,0$ #en-$"i "o!$#ine. L"o!$ $($n "i,0$ #en-$"i "o!$#ine !$"$ ne,*on "o!$#ine*gi( ole L$*o#$ti( $s$# $#ino "e($*0o(sil$se ;"o!$ "e($*0o(sil$se=. $l$,!,n "e#i(i$n $n+$ 1%9 "$*i LDo!$ #e#$s,(i ne,*on "o!$#ine*gi( sis$n+$ "i#et$0olis#e "i se#0$*$ng te#!$t #eng$(i0$t($n efe( s$#!ing +$ng l,$s. &$*en$ #e($nis#e fee"0$5( $($n te*-$"i ini0isi !e#0ent,($n LDo!$ en"ogen. $*0i"o!$ "$n 0ense*$/i"e $"$l$ "o!$ "e($*0o(sil$se ini0ito* #e#0$nt, #en5eg$ #et$0olis#e LDo!$ se0el,# #en5$!$i ne,*on "o!$#ine*gi(. Le?o"o!$ #eng,*$ngi t*e#o* (e($(,$n otot "$n #e#!e*0$i(i ge*$($n. Pen"e*it$ !en+$(it !$*(inson *ing$n 0is$ (e#0$li #en-$l$ni $(ti?it$sn+$ se5$*$ no*#$l. @0$t ini "i0e*i($n 0e*s$#$ 5$*0i"o!$ ,nt,( #ening($t($n efe(ti?it$sn+$ #eng,*$ngi efe( s$#!ingn+$. B$n+$( "o(te* #en,n"$ !engo0$t$n si#to#$tis "eng$n le?o"o!$ s$#!$i #e#$ng
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+$ng !$ling se*ing "ite#,($n #eli0$t($n $nggot$
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#en,n-,(($n ge-$l$ on-o$$ +$ng s$ng$t #engg$ngg, ($*en$ !en"e*it$ ti"$( t$, ($!$n ge*$($nn+$ #en"$"$( #en-$"i te*enti #e#0e(, s,lit. J$"i ge*$($nn+$ te*inte*,!si se-en$(. %= A0no*#$lit$s l$0o*$to*i,#. )*$n,losito!eni$ f,ngsi $ti $0no*#$l "$n ,*e,# "$*$ +$ng #ening($t #e*,!$($n (o#!li($si +$ng -$*$ng te*-$"i !$"$ te*$!i le?o"o!$. Efe( s$#!ing le?o"o!$ !$"$ !e#$($i$n 0e*t$,nt$,n $"$l$ "is(inesi$ +$it, ge*$($n #oto*i( ti"$( te*(ont*ol !$"$ $nggot$ ge*$( #$,!,n t,0,. Res!on !en"e*it$ +$ng #eng(ons,#si le?o"o!$ -,g$ se#$(in l$#$ se#$(in 0e*(,*$ng. Unt,( #engil$ng($n efe( s$#!ing le?o"o!$ -$"$l !e#0e*i$n "i$t,* "$n "iting($t($n "osisn+$ -,g$ "eng$n #e#0e*i($n t$#0$$n o0$t o0$t +$ng #e#ili(i #e($nis#e (e*-$ 0e*0e"$ se!e*ti "o!$#in $gonis @MT ini0ito* $t$, MA@B ini0ito*. 0. Agonis Do!$#in Agonis "o!$#in se!e*ti B*o#o(*i!tin ;P$*lo"el= Pe*goli" ;Pe*#$= P*$#i!eol ;Mi*$!e= Ro!ini*ol &$0e*golin A!o#o*fin "$n lis,*i" "i$ngg$! 5,(,! efe(tif ,nt,( #engo0$ti ge-$l$ P$*(inson. @0$t ini 0e(e*-$ "eng$n #e*$ngs$ng *ese!to* #en+e0$0($n
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1:
+$ng 0$n+$( "ig,n$($n ,nt,( !en+$(it !$*(inson +$it, t*ie+!eni"+l ;$*t$ne= "$n 0en/t*o!in ;5ongentin=. P*e!$*$t l$inn+$ +$ng -,g$ te*#$s,( golong$n ini $"$l$ 0i!e*i"on ;$(ineton= o*!en$"*ine ;"isi!$l= "$n !*o5+5li"ine ;($#$"*in=. Efe( s$#!ing o0$t ini $"$l$ #,l,t (e*ing "$n !$n"$ng$n ($0,*. Se0$i(n+$ o0$t -enis ini ti"$( "i0e*i($n !$"$ !en"e*it$ !en+$(it P$*(inson ,si$ "i$t$s 6 t$,n ($*en$ "$!$t #en+e0$0($n !en,*,n$n "$+$ ing$t. ". Peng$#0$t Mono$#in oi"$se ;MA@ Ini0ito*= Selegiline ;El"e!*+l= R$s$g$line ;A/ile5t=. Ini0ito* MA@ "i",g$ 0e*g,n$ !$"$ !en+$(it P$*(inson ($*en$ ne,*ot*$ns#isi "o!$#ine "$!$t "iting($t($n "eng$n #en5eg$ !e*,s$($nn+$. Selegiline "$!$t !,l$ #e#!e*l$#0$t #e#0,*,(n+$ sin"*o# P$*(inson "eng$n "e#i(i$n te*$!i le?o"o!$ "$!$t "it$ngg,($n sel$#$ 0e0e*$!$ $(t,. Be*g,n$ ,nt,( #engen"$li($n ge-$l$ "$*i !en+$(it P$*(inson +$it, ,nt,( #eng$l,s($n !e*ge*$($n. Selegilin "$n *$s$gilin #eng,*$ngi ge-$l$ "eng$n "eng$n #engini0isi #ono$#ine o(si"$se B ;MA@B= seingg$ #eng$#0$t !e*,s$($n "o!$#ine +$ng "i(el,$*($n ole ne,*on "o!$#ine*gi(. Met$0olitn+$ #eng$n",ng L$#!et$#in $n" L#et$#!et$#in. Bi$s$ "i!$($i se0$g$i (o#0in$si "eng$n g$0,ng$n le?o"o!$5$*0i"o!$. Sel$in it, o0$t ini -,g$ 0e*f,ngsi se0$g$i $nti"e!*es$n *ing$n. Efe( s$#!ingn+$ $"$l$ inso#ni$ !en,*,n$n te($n$n "$*$ "$n $*it#i$. e. A#$nt$"in Be*!e*$n se0$g$i !engg$nti "o!$#ine tet$!i 0e(e*-$ "i 0$gi$n l$in ot$(. @0$t ini ",l, "ite#,($n se0$g$i o0$t $nti?i*,s sel$n-,tn+$ "i(et$,i "$!$t #engil$ng($n ge-$l$ !en+$(it P$*(inson +$it, #en,*,n($n ge-$l$ t*e#o* 0*$"i(inesi$ "$n f$tig,e !$"$ $$l !en+$(it P$*(inson "$n "$!$t #engil$ng($n fl,(t,$si #oto*i( ;feno#en$ onoff= "$n "is(inesi$ !$"$ !en"e*it$ P$*(inson l$n-,t. D$!$t "i!$($i sen"i*i$n $t$, se0$g$i (o#0in$si "eng$n
le?o"o!$
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16
Ent$5$!one ;o#t$n= Tol5$!one ;T$s#$*=. @0$t ini #$si *el$tif 0$*, 0e*f,ngsi #eng$#0$t "eg*$"$si "o!$#ine ole en/i# @MT "$n #e#!e*0$i(i t*$nsfe* le?o"o!$ (e ot$(. M,l$i "i!$($i se0$g$i (o#0in$si le?o"o!$ s$$t efe(ti?it$s le?o"o!$ #en,*,n. Di0e*i($n 0e*s$#$ seti$! "osis le?o"o!$. @0$t ini #e#!e*0$i(i feno#en$ onoff #e#!e*0$i(i (e#$#!,$n $(ti?it$s (ei",!$n se$*i$*i. Efe( s$#!ing o0$t ini 0e*,!$ g$ngg,$n f,ngsi $ti seingg$ !e*l, "i!e*i(s$ tes f,ngsi $ti se5$*$ se*i$l. @0$t ini -,g$ #en+e0$0($n !e*,0$$n $*n$ ,*in 0e*$*n$ #e*$o*$n+e. g. Ne,*o!*ote(si Te*$!i ne,*o!*ote(tif "$!$t #elin",ngi ne,*on "$*i (e#$ti$n sel +$ng "iin",(si !*og*esifit$s !en+$(it. $ng se"$ng "i(e#0$ng($n se0$g$i $gen ne,*o!*ote(tif $"$l$ $!o!toti5 "*,gs ;EP 1346 $n" TT34:= l$/$*oi"s 0ioene*geti5s $ntigl,t$#$te*gi5 $gents "$n "o!$#ine *e5e!to*s. A"$!,n +$ng se*ing "ig,n$($n "i (lini( $"$l$ #ono$#ine oi"$se ini0ito*s ;selegiline $n" *$s$giline= "o!$#in $gonis "$n 5o#!le( I #ito5on"*i$l fo*tifie* 5oen/+#e 1.
Algo*it#$ !en$t$l$(s$n$$n !en+$(it P$*(inson
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Be*t,-,$n ,nt,( #e#!e*0$i(i $t$, #enge#0$li($n se!e*ti se#,l$ !*oses !$tologis +$ng #en"$s$*i ;ne,*o*esto*$si=. $. Te*$!i $0l$si lesi "i ot$( Te*#$s,( ($te*go*i ini $"$l$ t$l$#oto#+ "$n !$lli"oto#+ In"i($si < fl,(t,$si #oto*i( 0e*$t +$ng te*,s #ene*,s "is(inesi$ +$ng ti"$( "$!$t "i$t$si "eng$n !engo0$t$n #e"i( Dil$(,($n !eng$n5,*$n "i !,s$t lesi "i ot$( "eng$n #engg,n$($n ($,te*is$si. Efe( o!e*$si ini 0e*sif$t !e*#$nen se,#,* i",! "$n s$ng$t ti"$( $#$n ,nt,( #el$(,($n $0l$si "i(e",$ te#!$t te*se0,t. 0. Dee! B*$in Sti#,l$tion ;DBS= Dite#!$t($n se#$5$# ele(t*o"$ !$"$ 0e0e*$!$ !,s$t lesi "i ot$( +$ng "i,0,ng($n "eng$n $l$t !e#$5,n+$ +$ng "i!$s$ng "i 0$$ (,lit "$"$ se!e*ti $l$t !e#$5, -$nt,ng. P$"$ !*ose",* ini ti"$( $"$ !eng$n5,*$n lesi "i ot$( -$"i *el$tif $#$n. M$nf$$tn+$ $"$l$ #e#!e*0$i(i $(t, off "$*i le?o"o!$ "$n #engen"$li($n "is(inesi$. 5. T*$ns!l$nt$si Pe*5o0$$n t*$ns!l$nt$si !$"$ !en"e*it$ !en+$(it !$*(inson "i#,l$i 17'2 ole Lin"?$ll "$n ($$nn+$ -$*ing$n #e",l$ $"*en$lis ;autologous adrenal = +$ng #eng$sil($n "o!$#in. J$*ing$n t*$ns!l$n ;g*$ft= l$in +$ng !e*n$ "ig,n$($n $nt$*$ l$in "$*i -$*ing$n e#0*io ?ent*$l #esensef$lon +$ng #engg,n$($n -$*ing$n !*e#o*"i$l ste$# $t$, !*ogenito* 5ells non ne,*$l 5ells ;0i$s$n+$ fi0*o0l$st $t$, $st*os+tes= testis"e*i?e" se*toli 5ells "$n 5$*oti" 0o"+ e!iteli$l glo#,s 5ells. Unt,( #en5eg$ *e$(si !enol$($n -$*ing$n "i0e*i($n o0$t i##,nos,!*ess$nt 5+5los!o*in A +$ng #eng$#0$t !*olife*$si T 5ells seingg$ #$s$ i",! g*$ft -$"i le0i !$n-$ng. T*$ns!l$nt$si +$ng 0e*$sil 0$i( "$!$t #eng,*$ngi ge-$l$ !en+$(it !$*(inson sel$#$ 4 t$,n (e#,"i$n efe(n+$ #en,*,n 4 8 : t$,n ses,"$ t*$ns!l$nt$si. Te(ni(
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o!e*$si ini se*ing te*0ent,* 0e*#$5$# $#0$t$n se!e*ti (eti$"$$n "ono* (es,lit$n !*ose",* 0$i( te(nis #$,!,n !e*i-in$n.
. N4n )amak4l4gik
$. E",($si P$sien se*t$ (el,$*g$ "i0e*i($n !e#$$#$n #engen$i !en+$(itn+$ #is$ln+$ !entingn+$ #e#in,# o0$t te*$t,* "$n #engin"$*i -$t,. Meni#0,l($n *$s$ si#!$ti "$n e#!$ti "$*i $nggot$ (el,$*g$n+$ seingg$ ",(,ng$n fisi( "$n !si(i( #e*e($ #en-$"i #$(si#$l. 0. Te*$!i *e$0ilit$si T,-,$n *e$0ilit$si #e"i( $"$l$ ,nt,( #ening($t($n (,$lit$s i",! !en"e*it$ "$n #eng$#0$t 0e*t$#0$ 0e*$tn+$ ge-$l$ !en+$(it se*t$ #eng$t$si
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&e5en"e*,ng$n !ost,* t,0, +$ng s$l$ )e-$l$ otono# )$ngg,$n !e*$$t$n "i*i ;A5ti?it+ of D$il+ Li?ing 8 ADL= "$n Pe*,0$$n !si(ologi(. L$ti$n +$ng "i!e*l,($n !en"e*it$ !$*(inson #eli!,ti l$ti$n fisiote*$!i o(,!$si "$n !si(ote*$!i. L$ti$n fisiote*$!i #eli!,ti < l$ti$n gel$ng 0$, "eng$n tong($t l$ti$n e(stensi t*,n(,s l$ti$n f*en(le ,nt,( 0e*-$l$n "eng$n #en$!$(($n ($(i !$"$ t$n"$t$n"$ "i l$nt$i l$ti$n iso#et*i( ,nt,( (,$"*ise! fe#o*is "$n otot e(stenso* !$ngg,l $g$* #e#,"$($n #en$i(i t$ngg$ "$n 0$ng(it "$*i (,*si. L$ti$n o(,!$si +$ng #e#e*l,($n !eng($-i$n ADL !$sien !eng($-i$n ling(,ng$n ten!$t tingg$l $t$, !e(e*-$$n. D$l$# !el$(s$n$$n l$ti$n "i!$($i 0e*#$5$# st*$tegi +$it, < ∼
St*$tegi (ognitif < ,nt,( #en$*i( !e*$ti$n !en,>(onsent*$si 0i5$*$ -el$s "$n ti"$( 5e!$t #$#!, #engg,n$($n t$n"$t$n"$ ?e*0$l #$,!,n ?is,$l "$n $n+$ #el$(,($n s$t, t,g$s (ognitif #$,!,n #oto*i(.
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St*$tegi ge*$( < se!e*ti 0il$ $($n 0elo( s$$t 0e*-$l$n g,n$($n ti(,ng$n +$ng $g$( le0$* -$*$( (e",$ ($(i $*,s $g$( le0$* 0il$ ingin #e#,ng,t ses,$t, "il$nt$i.
∼
St*$tegi (esei#0$ng$n < #el$(,($n ADL "eng$n ",",( $t$, 0e*"i*i "eng$n (e",$ ($(i te*0,($ le0$* "$n "eng$n leng$n 0e*!eg$ng$n !$"$ "in"ing. Hin"$*i es($l$to* $t$, !int, 0e*!,t$*. S$$t 0e-$l$n "i te#!$t *$#$i $t$, l$nt$i ti"$( *$t$ $*,s (onsent*$si !en, -$ng$n 0i5$*$ $t$, #eli$t se(it$*.
Seo*$ng !si(olog "i!e*l,($n ,nt,( #eng($-i f,ngsi (ognitif (e!*i0$"i$n st$t,s #ent$l !$sien "$n (el,$*g$n+$. H$siln+$ "ig,n$($n ,nt,( #el$(,($n te*$!i *e$0ilit$si (ognitif "$n #el$(,($n inte*?ensi !si(ote*$!i.
. PRO&NOSIS
@0$to0$t$n +$ng $"$ se($*$ng $n+$ #ene($n ge-$l$ge-$l$ !$*(inson se"$ng($n !e*-$l$n$n !en+$(it it, 0el,# 0is$ "ienti($n s$#!$i s$$t ini. Se($li te*(en$ !$*(inson #$($ !en+$(it ini $($n #ene#$ni se!$n-$ng i",!n+$. T$n!$ !e*$$t$n g$ngg,$n +$ng te*-$"i #eng$l$#i !*og*ess ingg$ te*-$"i tot$l "is$0ilit$s se*ing "ise*t$i "eng$n (eti"$(#$#!,$n f,ngsi ot$( gene*$l "$n "$!$t #en+e0$0($n (e#$ti$n. Deng$n !e*$$t$n g$ngg,$n !$"$ seti$! !$sien 0e*0e"$0e*0e"$. &e0$n+$($n !$sien 0e*es!on te*$"$! #e"i($si. Pe*l,$s$n ge-$l$ 0e*(,*$ng "$n l$#$n+$ ge-$l$ te*(ont*ol s$ng$t 0e*?$*i$si. Efe( s$#!ing !engo0$t$n te*($"$ng "$!$t s$ng$t !$*$. Pen+$(it P$*(inson sen"i*i ti"$( "i$ngg$! se0$g$i !en+$(it +$ng f$t$l tet$!i 0e*(e#0$ng se-$l$n "eng$n $(t,. R$t$*$t$ $*$!$n i",! !$"$ !$sien P$*(inson !$"$ ,#,#n+$ le0i *en"$ "i0$n"ing($n +$ng ti"$( #en"e*it$ P$*(inson. P$"$ t$$! $(i* !en+$(it P$*(inson "$!$t #en+e0$0($n (o#!li($si se!e*ti te*se"$( !ne,#oni "$n #e#0,*,( +$ng "$!$t #en+e0$0($n (e#$ti$n. P*og*esifit$s ge-$l$ !$"$ P$*(inson "$!$t 0e*l$ngs,ng 2 t$,n $t$, le0i. N$#,n "e#i(i$n !$"$ 0e0e*$!$ o*$ng "$!$t le0i sing($t. Ti"$( $"$ 5$*$ +$ng te!$t ,nt,( #e#!*e"i(si($n l$#$n+$ !en+$(it ini !$"$ #$sing#$sing in"i?i",.
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Deng$n t*e$t#ent +$ng te!$t (e0$n+$($n !$sien P$*(inson "$!$t i",! !*o",(tif 0e0e*$!$ t$,n setel$ "i$gnosis.
BAB III PEN**P
Pen+$(it P$*(inson $"$l$ !en+$(it ne,*o"egene*$tif +$ng 0e*sif$t (*onis !*og*esif #e*,!$($n s,$t, !en+$(it>sin"*o# ($*en$ g$ngg,$n !$"$ g$ngli$ 0$s$lis $(i0$t !en,*,n$n $t$, ti"$( $"$n+$ !engi*i#$n "o!$#ine "$*i s,0st$nsi$ nig*$ (e glo0,s !$li",s> neost*i$t,# (striatal dopamine de$iciency'. Di A#e*i($ Se*i($t $"$ se(it$* %. !en"e*it$ !$*(inson. Di In"onesi$ sen"i*i "eng$n -,#l$ !en",",( 21 -,t$ o*$ng "i!e*(i*$($n $"$ se(it$* 2.4. !en"e*it$ Pen+$(it P$*(inson #e*,!$($n !en+$(it (*onis +$ng #e#0,t,($n !en$ng$n$n se5$*$ olisti( #eli!,ti 0e*0$g$i 0i"$ng. P$"$ s$$t ini ti"$( $"$ te*$!i ,nt,( #en+e#0,($n !en+$(it ini tet$!i !engo0$t$n "$n o!e*$si "$!$t #eng$t$si ge-$l$ +$ng ti#0,l . @0$to0$t$n +$ng $"$ se($*$ng $n+$ #ene($n ge-$l$ge-$l$ !$*(inson se"$ng($n !e*-$l$n$n !en+$(it it, 0el,# 0is$ "ienti($n s$#!$i s$$t ini. Se($li te*(en$ !$*(inson #$($ !en+$(it ini $($n #ene#$ni se!$n-$ng i",!n+$. T$n!$ !e*$$t$n g$ngg,$n +$ng te*-$"i #eng$l$#i !*og*ess ingg$ te*-$"i tot$l "is$0ilit$s se*ing "ise*t$i "eng$n (eti"$(#$#!,$n f,ngsi ot$( gene*$l "$n "$!$t #en+e0$0($n (e#$ti$n. Deng$n !e*$$t$n g$ngg,$n !$"$ seti$! !$sien 0e*0e"$0e*0e"$. &e0$n+$($n !$sien 0e*es!on te*$"$! #e"i($si. Pe*l,$s$n ge-$l$ 0e*(,*$ng "$n l$#$n+$ ge-$l$ te*(ont*ol s$ng$t 0e*?$*i$si. Efe( s$#!ing !engo0$t$n te*($"$ng "$!$t s$ng$t !$*$.
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DA)AR P*SAKA
1. S-$*i* H N$s,tion D )ofi* A. P$*(insonKs Dise$se @te* Mo?e#ent Diso*"e*s. P,st$($ e"e(i$ "$n De!$*te#en Ne,*ologi F& USU Me"$n. 26. H$l 4%3. 2. S,"o+o A Seti+o$"i B Ali I. Pen+$(it P$*(inson. B,(, A-$* Il#, Pen+$(it D$l$# Jili" III. F&UI. 26. H$l 13631366. 3. P*i5e SA ilson LM H$*tig MS. )$ngg,$n Ne,*ologis "eng$n Si#to#$tologi )ene*$lis$t$. P$tofisiologi &onse! &linis P*oses!*oses Pen+$(it ol 2. Pene*0it B,(, &e"o(te*$n E). 2:. H$l 11371144. 4. H$*sono. Pen+$(it P$*(inson. B,(, A-$* Ne,*ologis &linis. Pe*i#!,n$n Do(te* S!esi$lis S$*$f In"onesi$ "$n U)M. 2'. H$l 233243. %. D,,s Pete*. Di$gnosis To!i( Ne,*ologi An$to#i Fisiologi T$n"$ "$n )e-$l$ E"isi II. Pene*0it B,(, &e"o(te*$n E). 177:. H$l 231243.
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